2025 COLLEGE STATE DELEGATE APPLICATION Survey

Thank you for your interest in serving as a College State Delegate for the House of Delegates (HOD). Diversity and experience in governmental, political and advocacy groups is what makes our organization great. Below are questions and information that help the College leaders know who you are and what experience you have or could bring to represent our members in the best manner. Serving as a delegate is an important way to support our members and ensure the allergy specialty continues.

Please keep the following in mind:
* You must be an active College member to apply.
* Delegates serve for five-year terms.

Delegates from each state will be chosen by College leadership to strengthen our advocacy network. They will serve as the liaison between local, state and regional allergy societies and the Advocacy Council. Delegates will monitor local legislation; establish contacts with local and state legislators, allergists and regional allergy societies. They will share advocacy information with HOD leaders, super-delegates and Advocacy Council leaders. More details are available at https://college.acaai.org/college-delegate-job-description/

Please complete the following application form. Applications are being accepted Feb. 21 - April 30, 2025. All submitted applications will be vetted by the HOD’s Nominating Committee; one representative from each state will be chosen for a five-year term. All applicants will be notified of their status no later than Aug. 1.

We are looking for state delegates from Delaware, Hawaii, Illinois, Indiana, Iowa, Minnesota, North Dakota, South Carolina, South Dakota, Tennessee, Vermont, Washington, West Virginia and Wyoming.

1.Please provide your name and contact information.

Last Name

First Name, Middle

Email Address

Cell Phone Number

2.Where do you practice? (If you have more than one office, list your main office.)

City/Town

State/Province

3.How many years have you practiced in this state?

4.Are you Board Certified in allergy?

Yes

5.Are you a practicing allergist?

Yes

6.What issue(s) are you passionate about?

7.List your relationships with: (organization names)

Political organization(s)

Community organization(s)

State medical society

Lobbyist

Local allergy society

Regional allergy society

State allergy society

8.Have you held leadership positions with any of the above organizations/societies?

Yes

If you answered yes, please pair the society with the position held i.e., ABC Allergy Society - President - 2020-2022.

9.List your relationships with: (name/relationship, i.e., Senator Tammy Duckworth - consultant on epinephrine on airplanes)

State legislators

Federal legislators

Lobbyists

10.Which of the following advocacy-related activities have you participated in? Select all that apply:

Participated in grassroots advocacy efforts

Engaged with elected officials

Organized or participated in public awareness campaigns

Supported policy change initiatives

Collaborated with third-party or local payers

Other (please specify)

11.Which of the following accomplishments best describes your relevant experience? Select all that apply:

Served in a leadership role in an advocacy organization or initiative

Published articles on advocacy topics

Secured meetings with legislators

Organized or led an advocacy campaign

Other (please specify)

12.Select the options that best reflect why you want to be a state delegate:

To advocate for policies that improve patient care.

To represent my state’s needs at the national level.

To collaborate with peers on key advocacy initiatives.

To contribute my expertise to influence healthcare policy.

To gain experience in advocacy efforts

Other (please specify)